Physiotherapy Video Case Study

David's Story - Back pain, balance, falls prevention and general mobility

“David has been affected by thalidomide. For him, this has resulted in a shortened left leg and significantly shortened arms. Up until 3 years ago, David was feeling well and had no major concerns about pain, balance or falls.

He started having back pain around 3 years ago but told me that he has never injured his back in an accident or fall. After suffering the pain gradually getting worse over a few months, like many people, David went to his GP for advice. Unfortunately, he was told that ‘it’s just wear and tear’ and that there is ‘not much that can be done about it’.

He was, understandably, upset and believed that there was nothing that he could do to help his pain, other than take pain killers, and he just had to live with it.

Over the next few years, David’s pain gradually worsened and started affecting most parts of his life. He stopped going out as much because he knew it would make his pain worse. His back pain was affecting his confidence to go out and take part in the activities he would normally enjoy, making him less and less active. Because of this he started having problems with his balance and general fitness. As time went on and his back pain got worse, David started feeling more off balance and increasingly worried he might fall.
As you would expect, this cycle continued.

Ultimately, David did have a fall. He was walking around his house as usual when his left leg gave way. He landed on his back and had a very difficult job of getting up off the floor. Thankfully, he was not physically injured, however, the fear of falling and the fear of not being able to help himself get back up has stayed with him.

This is not an unusual story

David is a wonderfully unique human being, but his story is quite common, whether or not you have been affected by thalidomide. It is very frustrating knowing that this is happening in the UK but focusing on the ‘why’ this is happening is not always within our ability to control. More importantly, as David found out, focusing on the ‘what can I do to help myself?’ is the better line of questioning and has, ultimately, changed his life for the better.

Where did I come in?

David initially spoke about his back pain and problems with balance and falls with a Medical Advisor at the Thalidomide Trust, in 2017.

She researched local physiotherapists and contacted me specifically because I specialise in working with adults who have problems with balance and falls, asking if I would be able to work with David to see how physiotherapy would make a difference. After hearing a brief background of David’s difficulties, I thought I would be able to help.

Over the next several months, David and I worked closely together, first tackling his back pain. Once that was better, we started focusing on improving his balance, walking, ability on the stairs and preventing falls.

I am very happy to say that David has made great improvements. He no longer suffers from any back pain and he is now able to get back out and enjoy his life. He is going up and down the stairs more easily and feels that he is a lot more confident. Another really nice change is that he can now confidently get off the floor under his own steam, meaning that if he does have another fall he is confident that he will be able to get back on his feet without help.

Since I started working with David, he has been away on a cruise and is now back going to the football with his son.

As we were coming towards the end of our sessions, David said that he was not keen to attend local exercise classes because he is self-conscious about how he looks. I raised this with the Thalidomide Trust, who advised me that these feelings are very common for beneficiaries and that some beneficiaries prefer a 1 to 1 session with an exercise instructor rather than group classes. With this in mind, the Trust researched local Pilates instructors who have experience working with people with physical difficulties. David is now attending 1 to 1 sessions with a Pilates Instructor and he told me that he is really enjoying the sessions and that they are helping to keep him going.

What does a physiotherapist do?

David and I had an initial assessment where we had a really informative chat about his back pain and the problems he was facing with his balance and falls. I then had a good look at David’s’ posture, muscle strength and how well he balances, walks and goes up and down the stairs.

We highlighted that the way that David moved his back and the shortening of his left leg (by about 1 inch or so) was putting a lot of pressure on the joints at the bottom of his back, which was likely to be causing his pain. His balance and problems with his walking were mainly due to the shortened left leg and significant weakness of the muscles in it.

We then discussed David’s goals for treatment. These were:
1)     To improve his back pain to allow him to get out and about more
2)     Get more confident at going up and down the stairs
3)     Reduce his fear and anxiety about falls
4)     Get back to enjoying his holidays and going to watch the football

We were then able to put together a Plan of Care to start to ‘fix’ the problems we found in the Initial Assessment.

What happened next?

I spoke to the Trust about the findings from David’s assessment and my recommendations for treatment. One of the first things that they helped with was organising an Orthotist to assess David for a custom-made insole for his left foot to help correct the leg shortening. The specially fitted insole made a really nice improvement in David’s posture and walking pattern and helped ‘off-load’ some of the strain on his back.

We then used a combination of manual therapy techniques and posture re-education exercises to
1)    Improve the movement of the stiff joints in David’s back, and
2)    Correct his posture – which helps take further pressure of painful and stiff joints in his back and to try and stop his pain from coming back.

David responded well to the treatment plan and has been pain free for several months.

Balance, walking and falls

David and I then started working on an exercise programme that he could easily carry out in his own home. The exercises were specifically targeted to improve his left leg strength, balance and his ability on the stairs. Over the course of a few months and David putting in the hard work each day, we saw a really nice improvement in the strength in his leg, the way he walks and his overall confidence at activities like going up and down the stairs and going out to the football. David also feels a big improvement in the fear he has of falling since we have completed his physiotherapy.

David has been a terrific person to work with and has made brilliant improvements through his own hard work and determination to not let his pain, balance problems and fears get him down.”